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Malignancies of the Appendix: Beyond Case Series Reports

  • Original Contribution
  • Published:
Diseases of the Colon & Rectum

Abstract

PURPOSE

A comprehensive analysis was performed for five histologic types of appendiceal tumors to compare incidence, clinicopathologic features, survival, and appropriateness of surgery.

METHODS

All patients diagnosed with mucinous adenocarcinoma (n = 951), adenocarcinoma (n = 646), carcinoid (n = 435), goblet (n = 369), and signet-ring cell (n = 113) in the Surveillance, Epidemiology, and End Results database (1973–2001) were analyzed. Evaluation of incidence, stage, and five-year relative survival were determined for each histology. The appropriateness of the operative procedure (i.e. , appendectomy vs. colectomy) was examined by tumor type and size.

RESULTS

Tumor incidence, patient demographics, survival outcomes, and appropriateness of surgery varied significantly among the different appendiceal tumor histologies. The most common appendiceal tumors were mucinous. With regard to patient demographics, carcinoids presented at an earlier mean age of 41 years and 71 percent were female (P < 0.001 for both). Overall five-year survival was highest for carcinoid (83 percent) and lowest for signet ring (18 percent). Although current guidelines specify that a right hemicolectomy (rather than an appendectomy) be performed for all noncarcinoid tumors and carcinoid tumors >2 cm, we found that 30 percent of noncarcinoids underwent appendectomy. Similarly, 28 percent of carcinoids >2 cm under-went appendectomy, which is a lesser resection than is indicated.

CONCLUSIONS

This study provides a population-based analysis of epidemiology, tumor characteristics, survival, and quality of care for appendiceal carcinomas. This characterization provides a novel description of the presentation and outcomes for malignancies of the appendix and highlights that a substantial number of patients with appendiceal tumors may not be receiving appropriate surgical resection.

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Authors and Affiliations

  1. Department of Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California

    Marcia L. McGory M.D., Melinda A. Maggard M.D., M.S.H.S., Jessica B. O’Connell M.D. & Clifford Y. Ko M.D., M.S., M.S.H.S.

  2. Department of Surgery, Daehang Hospital, Seoul, Korea

    Hakjung Kang M.D., Ph.D.

  3. Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, California

    Clifford Y. Ko M.D., M.S., M.S.H.S.

Authors
  1. Marcia L. McGory M.D.
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  2. Melinda A. Maggard M.D., M.S.H.S.
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  3. Hakjung Kang M.D., Ph.D.
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  4. Jessica B. O’Connell M.D.
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  5. Clifford Y. Ko M.D., M.S., M.S.H.S.
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Corresponding author

Correspondence to Marcia L. McGory M.D..

Additional information

Supported in part by a Limited Project Grant from The American Society of Colon and Rectal Surgeons Research Foundation and the Robert Wood Johnson Clinical Scholars Program at the University of California Los Angeles.

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McGory, M., Maggard, M., Kang, H. et al. Malignancies of the Appendix: Beyond Case Series Reports. Dis Colon Rectum 48, 2264–2271 (2005). https://doi.org/10.1007/s10350-005-0196-4

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  • DOI: https://doi.org/10.1007/s10350-005-0196-4

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